Nursing Care Plan for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)

Watch for signs / symptoms of hypovolemia including:

• Hypotension
• Tachycardia
• Fever

Severe diarrhea may lead to incontinence of bowels, especially in patients with limited mobility. Provide perineal care every 2-4 hours or as needed to prevent breakdown of skin and infections. Make sure to clean from front to back, and between skin folds of the buttocks and scrotum. Apply barrier cream as appropriate to protect skin.

• Rule out bacterial, viral or parasitic infection
• Determine if supplementation is necessary
  • Potassium
  • Magnesium
  • Sodium
  • Acid-base balance

Rest decreases intestinal motility when diarrhea is a problem. If patient has frequent urge to defecate, provide bedside commode to prevent incontinence and reduce risk of falls

Note number, character, and amount of stools to determine renal function, bowel disease control and need for fluid replacement; daily weights may be necessary

• Patients must be fasting, no food or drink for 4-8 hours prior to the procedure
• Administer conscious sedation
• Monitor vitals while patient is sedated per facility policy
• Assist with ambulation immediately following procedure until sedation is fully worn off
• NPO until gag reflex returns

Dry mouth from an NPO status can cause a build up of bacteria and fungus in the mouth resulting in ulcerations, thrush and cavities.

• Assess oral mucosa and inspect for dried secretions in the roof of the mouth that may impair breathing.
• Swab mouth every 2-4 hours for hydration and comfort
• Use wet toothbrush without toothpaste to clean teeth, gums and tongue to prevent aspiration
• Suction secretions as necessary

• Anti-inflammatories– corticosteroids such as prednisone or hydrocortisone
• Immunosuppressants– azathioprine, cyclosporine
• Antibiotics– metronidazole, ciprofloxacin
• Anti-diarrheal– loperamide
• Pain reliever– acetaminophen (NSAIDS are contraindicated)
• Iron supplements– as needed for iron-deficiency anemia due to intestinal bleeding

• Change ostomy system as needed per facility protocol, usually every 2-4 days
• Empty the ostomy pouch when ⅓ full
• Clean stoma with each bag change, using soap and warm water, avoiding alcohol based cleaners.
• Assess the skin around the stoma for bruising or ulceration
• The stoma should be pink or red

• Limit or avoid alcohol which may increase diarrhea
• Exercise- healthy diet and exercise help to normalize bowel function
• Stop smoking- smoking increases the risk of Crohn’s and the frequency of recurrences
• Reduce stress- many patients report symptom flares during periods of high stress

• Limit dairy products due to correlation with lactose intolerance
• Increase low-fat foods- with Crohn’s disease, fat passes through the intestine instead of being absorbed making diarrhea worse
• Limit fiber- includes raw fruits, vegetables and whole grains
• Limit other problem foods- spicy foods, alcohol, caffeine
• Eat small frequent meals
• Drink plenty of fluids- water is best